Knowledge Check!

During our last lecture we had Professor Flick present about health promotion, health literacy, and prevention. She was very engaging in our session and we learned many things about current health topics. One of the first things I learned was the IHI Triple Aim. This is an objective to improve healthcare quality and satisfaction for individuals. The three focuses in this aim are population health, experience of care, and lowering per capita cost. This aim also helps broaden reach of health and and wellness for all individuals!
    Another topic that I learned was about the social determinants of health. Some of these are education, food, income, shelter, and many more. I enjoyed the dialogue we had in class about some of these determinants and how if one of them were to change then it could totally change the trajectory of the person's life. Take education for example, if someone had access to a good education and was able to get a decent paying job after graduation, then the person's life would change and they  could change the next generation's lives. I think this is a paradigm that we should all take a more serious look at.
    Lastly, I also learned about the different levels of disease prevention and interventions. The levels are primary, secondary, and tertiary. Professor Flick explained in great detail the differences between the three levels. I believe there is a large push for Primary prevention in the United States today. If there are preventative methods you can take to prevent the disease from ever occurring this would drastically change our current healthcare system. I believe maintenance and improving quality of life for individuals is incredibly important; however, if primary prevention is available it should be number one.

Biomechanics Blog Post #3

The clinical relevance of the Scapulohumeral Rhythm is vital to understanding and measuring the motion in the shoulder joint. There is a ratio of movement between the scapula and humerus and when this ratio is disturbed it can cause implications with our clients. There is a 2:1 ratio for range of motion in the shoulder joint. If a client moves their shoulder 3 degrees, the humerus will move 2 degrees and the scapula will move 1 degree. For example, a client with full 180 degrees of shoulder abduction, the humerus would move 120 degrees and the scapula would only move 60 degrees. There is a synchronization between the movements of the humerus and scapula. One implication involved in a disrupted scapulohumeral rhythm is impingement syndrome. This is when the subacromial space in the shoulder joint is compressed and the supraspinatus tendon is trapped and cannot function like it normally would. This would cause severe pain for our client. Another relevance for the scapulohumeral rhythm is to promote an optimal length-tension relationship between muscles. The length-tension relationship ensures a muscle will be at the optimal length to produce a strong contraction. It allows for the most actin and myosin to cross-bridge to form the contraction. An impaired scapulohumeral rhythm could produce an active insufficiency between the muscles. Lastly, another relevance of the scapulohumeral rhythm is the promotion of joint congruency. The head of the humerus articulates with the glenoid fossa of the scapula in such a way to promote the greatest range of motion (ROM). If there is no rhythm between the movements of the scapula and humerus this will cause the congruency between this joint to be lost. 
    

Biomechanics Blog Post #2

It is very important to palpate bony landmarks when measuring ROM to have a high inter-rater and intra-rater reliability. This allows for multiple therapists to palpate the same bony landmark so they are measuring from the same location. It also gives the same therapist a landmark to come back to when remeasuring the joint. Doing this ensures you are measuring from the exact same position for ROM in the same joint. Also, using the proper positioning when measuring ROM makes certain you will measure the joint’s full range of motion. If body is improperly positioned then the measurement will be faulty and the client’s joint will not be measured to it’s maximum potential. For example, if you are measuring knee flexion ROM and you place your client’s leg off the table then you have the potential to improperly measure the joint’s full ROM with the leg not positioned properly.

    The purpose of the “test position” for a MMT is to ensure the muscle can reach optimal contractibility. You want to place the muscle is in the proper position so that it can reach full contraction. For example, placing an individual’s leg hanging off the treatment table is OPTIMAL for performing a MMT on quadriceps extension. This allows the greatest contraction of the muscles. If you placed the individual’s leg on the treatment table in a flexed position, the muscle would not be able to produce as great of a contraction. Another reason for “test position” is so that the therapist can be in the best position to apply pressure for the “break test.” The therapist needs to be in a good position so that he/she can apply the right amount of pressure for this test; if he/she doesn’t then the client will receive an improper reporting of their muscle strength. Also, the therapist needs to be in proper positioning to apply the pressure on the distal portion of the joint they are testing. The therapist should never apply pressure across multiple joints because this will give a faulty reading of the muscle strength of the joint being tested. If the therapist and client is in the proper position then the therapist will be able to apply pressure on the distal portion of the joint being measured.

    Lastly, the relevance of the gravity eliminated position is for clients that cannot move through the full available ROM and will be scored below a 3 on the MMT scale. Individuals needing to be tested in a gravity eliminated position do not have the muscle strength to move through the full available range of motion against gravity, so they will need to be tested without gravity in order to measure their muscle strength. Some individuals will not have any muscle activity at all.

    

Knowledge Check

I listened to the "OT's Role in Promoting Driving Independence" podcast. This was a very interesting podcast with a dialogue of two OTs and a certified driving rehabilitation specialist. They discussed many topics in regards to her role as a certified driving rehabilitation specialist. They first discussed about how the older population accounts for 8% of car crash related activity and 14% of driving fatalities. This numbers are astonishing to me because I feel that these numbers are preventable and should be lower. Another interesting fact that was mentioned was most individuals that have suffered from a TBI stop driving simply because their friends and family say they should stop driving. Many individuals could have a better quality of life if they received therapy or evaluations and were able to drive on their own. They have halted their driving because of the comfort level of another person. 

    During the second portion of the podcast the OTs interviewed a certified driving rehab specialist. She gave insight into her position and how she is the only driving rehabilitation specialist in the state of Nevada. She stated there is no referral necessary from a physician and that some insurances will cover her services. With her position, she assesses the individuals home, their car, their cognitive, physical, emotional, and proprioceptive skills. Sometimes the individual will be very confident in their driving and then after the assessment she will have to inform them they should not be driving. Also, some individuals should be driving when they are not confident or comfortable with that fact. I feel that driving is such a vital part of someone's social and environmental freedom. It makes me reminisce of turning 16 years old and being able to drive by yourself for the first time. It allows for "freedom" and taking that ability away forces you to rely on another individual or system to transport you places. I think one piece I took away from the podcast and the driving rehabilitation specialist was to accept the client where they are. We must accept the client in their living situation, family situation, or mental state. Whenever we do this, we will be able to put forth the best effort to help them regain their independence and help them live the best life possible.

  

Biomechanics Blog Post #1

One movement that is a part of my morning routine is pouring a glass of milk. One of the movements after getting the milk out of the refrigerator is twisting the top off. Twisting off the cap requires grasping the cap and wrist adduction. Some tops are "pop off" and they require more supination of the forearm instead of wrist adduction. After the top is off I have to flex the elbow to lift the jug. While flexing the elbow, the shoulder is also abducting. In order to pour the milk into a glass the last movement is wrist adduction. This will instill the milk reaches the glass steadily.
    There are several joints being acted on while pouring a glass of milk. During elbow flexion, the sagittal plane, during shoulder abduction and wrist adduction, the frontal plane. There are also many axes being acted on during this movement. Elbow flexion is moving around the frontal axis, shoulder abduction and wrist adduction is occurring around the sagittal axis.
    The osteokinematics of the shoulder joint during the pouring is mainly shoulder abduction. I am abducting my shoulder to ensure the jug will be at the proper angle to pour into a glass. During shoulder abduction, it is visible that the humerus is moving further away from the midline of the body. In regards to the arthrokinematics during this movement, the head of the humerus glides inferiorly in the glenoid fossa. Because of the concave-convex rule, this allows the head of the humerus to stay in contact with the gleniod fossa.
   The prime movers of this movement are biceps brachii, brachialis, and brachioradialis during elbow flexion. Some other prime movers are the middle deltoid and supraspinatus during shoulder abduction. Lastly, during wrist adduction the prime movers are extensor carpi ulnaris and flexor carpi ulnaris. During elbow flexion, the biceps brachii, brachialis, and brachioradialis are contracting concentrically. Also, during shoulder abduction the middle deltoid is contracting concentrically because the muscle is shortening. Lastly, during wrist adduction, the extensor carpi ulnaris and the flexor carpi ulnaris are both contracting concentrically.
    Pouring a glass of milk is a vital part of my day. It has been interesting looking at all the movements involved in getting a glass of milk.